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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 65-66

Median raphe cyst of the prepucial skin: A case report with brief review of literature


Department of Pathology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India

Date of Web Publication12-Feb-2018

Correspondence Address:
Zeenat S Imam
Senior Resident, Dept. of Pathology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna - 800014, Bihar
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Median raphe cyst is a rare benign cystic lesion, located in the midline, anywhere between the external urethral meatus and the anus. We report a case of 60 year old male, who presented with a recently enlarging, cystic, mobile, painful, fluctuant swelling in the foreskin. He underwent excision of the prepucial cyst along with circumcision. Histopathological features were consistent with prepucial median raphe cyst. This case is being presented for it’s rare location, uncommon clinical presentation and an interesting mixed lining epithelium on histopathological examination.

Keywords: Circumcision, Cyst, Median, Prepucial, Raphe


How to cite this article:
Imam ZS, Chandra K, Choudhary V, Kumar B. Median raphe cyst of the prepucial skin: A case report with brief review of literature. J Indira Gandhi Inst Med Sci 2018;4:65-6

How to cite this URL:
Imam ZS, Chandra K, Choudhary V, Kumar B. Median raphe cyst of the prepucial skin: A case report with brief review of literature. J Indira Gandhi Inst Med Sci [serial online] 2018 [cited 2022 Aug 10];4:65-6. Available from: http://www.jigims.co.in/text.asp?2018/4/1/65/302993




  Introduction : Top


Median raphe cyst is an uncommon, benign cystic lesion. It can develop along the midline on the ventral surface of the male genitalia, anywhere between the tip of the penis and anus[1]. The commonly reported sites of occurrence are the penile shaft and the glans penis[2]. In most patients, the cyst which is asymptomatic or unrecognized during childhood, may become symptomatic during adolescence or adulthood, due to infection or trauma. The clinicopathological spectrum and the pathogenesis of the disease is not well understood. We are presenting a case of prepucial median raphe cyst which presented with symptoms in an elderly of Indian origin.


  Case Report : Top


A 60year old, male patient presented with the complains of swelling in the foreskin, pain and difficulty during micturition. His past history revealed that the swelling, which was initially pea sized, was present from childhood and was asymptomatic. The swelling had gradually increased in size during the last three years with recent development of pain along with difficulty in micturition. There was no other relevant clinical history. Clinical examination revealed a 4x3cm soft, cystic, mobile, fluctuant swelling arising from the prepucial skin, on the ventral aspect of the penis. The skin over the swelling appeared normal and was not attached to the penile body or the glans penis. The patient underwent excision of the prepucial cyst along with circumcision.

Grossly the specimen measured 4x2x1cm, was covered with skin on one surface and was soft in consistency. Cut section showed an irregular cyst, which was collapsed and had smooth inner surface. Histopathological examination of multiple sections showed a cystic lesion covered by skin and subcutaneous tissue, comprising of fibromuscular stroma and infiltrated by chronic inflammatory cell infiltrates [Figure 1]. The cyst wall showed a variable lining with flat to stratified cuboidal to transitional type of epithelium [Figure 2], [Figure 3], [Figure 4]. The site and the histopathological findings led to the diagnosis of median raphe cyst of the prepucial skin of the penis.
Figure 1: H & E (40X) Cystic lesion covered with skin and areas of subcutaneous tissue showing fibromuscular stromal connective tissue. Cyst lining varied from area to area.

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Figure 2: H & E (10X) Cyst lined with stratified cuboidal to flat to transitional epithelium.

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Figure 3: H & E (40X) Cyst lined with stratified cuboidal epithelium

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Figure 4: H & E (40X) Focal area of cyst lined by flattened epithelium.

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  Discussion : Top


Median raphe cysts are rare, congenital lesions, along the male external genitalia. Several synonymous terms, including mucus cyst of the penis, genitoperineal cyst of the median raphe, parameatal cyst, hydrocystoma and apocrine cystadenoma of the penile shaft have been used in the past. These type of cysts have been reported since 1910[3]. The pathogenesis of this disease has not been fully understood. Three different mechanisms have been described including (i) fusion defect of urethral folds (ii) development of the ectopic periurethral glands of Littre and (iii) development from the urethral columnar epithelium followed by separation[2]. As per the first theory, depending on the nature of the trapped tissue, the lining of the cyst may vary[4]. As such four different types have been recognised. These are (i) pseudostratified columnar epithelium (if proximal urethral cells are trapped) (ii) squamous epithelium (if distal urethral cells are trapped) (iii) glandular epithelium (if periurethral glands are trapped) and (iv) mixed type. Our case belonged to the mixed type epithelium group as it contained all the three elements.

Most of the cases of median raphe cyst are asymptomatic and unrecognized during childhood, more so due to the proximal locations of the cysts in the genitalia and their small size (usually less than 2cm). They may slowly progress and may become symptomatic during adolescence or adulthood. The more distal the location of the cysts, and bigger the size of the cyst, greater will be the manifestation of the symptoms, such as pain (due to trauma or infection), dysuria, haematuria, haematospermia and difficulty in having sexual intercourse[5]. Our patient presented with the complains of pain, increase in the size of cyst and difficulty during micturition.

The most common location of these cysts are penile shaft and the parameatal position. Very rarely median raphe cysts involving the prepuce have been reported. Differential diagnosis includes urethral diverticulum, dermoid cyst, glomus tumour, pilonidal cyst, steatocystoma and epidermal inclusion cyst[4].

Treatment of median raphe cyst is simple surgical excision and primary closure[6]. Surgery should be considered for symptomatic lesions and cosmetic purposes. Medical intervention may be required due to secondary infection and pain.


  Conclusion : Top


Median raphe cyst is a rare benign lesion resulting from tissue trapping during the development of urethral folds. The associated signs and symptoms should be taken into consideration when determining the treatment of these cysts.



 
  References Top

1.
Vasseur JGL, Perry VE, Perineal median raphe cyst. Pediatric Dermatology 1997;5:391-2.  Back to cited text no. 1
    
2.
Shao HI, Chen TD, Shao T, Chen HW. Male median raphe cysts : serial retrospective analysis and histopathological classification. Diagnostic Pathology 2012;7:121-2.  Back to cited text no. 2
    
3.
Otsuka T, Ueda Y, Terauchi M, Kinoshita Y. Median raphe (parameatal cysts) of the penis. The Journal of Urology. 1998;6:1918-20.  Back to cited text no. 3
    
4.
Nagore E, Sanchez-Motilla JM, Febrer MI, Aliaga A. Median raphe cyst of the penis : a report of five cases. Pediatric Dermatology 2013;15:191-3.  Back to cited text no. 4
    
5.
Giannakopoulos S, Markis NE, Kalaitzis C, Papatsoris AG, Pantazis T, Touloupidis S. Two unusual cases of median raphe penile cysts. European Journal of Dermatology 2013;17:342-3.  Back to cited text no. 5
    
6.
Soyer T, Karabulut AA, Boybeyi O, Gunal YD. Scrotal pearl is not always a sign of anorectal malformation : median raphe cyst. Turkish Journal of Pediatrics 2013;6:665-6.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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